Category Archives: Health Care

Women at Risk: Why Many Women Are Forgoing Needed Health Care

Source: Sheila D. Rustgi, Michelle M. Doty, and Sara R. Collins, Commonwealth Fund, Issue Brief, May 2009

From the press release:
Women are more likely than men to feel the pinch of rising health costs and eroding health benefits, with about half (52%) of working-age women reporting problems accessing needed care because of costs, compared to 39 percent of men, a new Commonwealth Fund study finds. Women who are insured but have inadequate coverage are especially vulnerable: 69 percent of underinsured women have problems accessing care because of costs, compared to half (49%) of underinsured men.

The study, Women at Risk: Why Many Women Are Forgoing Needed Health Care, by Commonwealth Fund researchers Sheila Rustgi, Michelle Doty, and Sara Collins finds that overall, seven of 10 working-age women, or an estimated 64 million women, have no health insurance coverage or inadequate coverage, medical bill or debt problems, or problems accessing needed health care because of cost.
See also:

National Healthcare Quality Report, 2008

Source: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, AHRQ Publication No. 090001, March 2009

Health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need or they receive care that causes harm. Care can be delivered too late or without full consideration of a patient’s preferences and values. Many times, our system of health care distributes services inefficiently and unevenly across populations.

Each year since 2003, the Agency for Healthcare Research and Quality (AHRQ), together with its partners in the Department of Health and Human Services (HHS), has reported on progress and opportunities for improving health care quality, as mandated by the U.S. Congress. The information amassed for the National Healthcare Quality Report (NHQR) since its inception is a growing knowledge base that addresses two critically important questions:
◆ What is the status of health care quality in the United States?
◆ How is the quality of the health care delivered to Americans changing over time?

Hard Times in the Heartland

Source: Meena Seshamani, Joan Van Nostrand, Jenna Kennedy, Carrie Cochran, U.S. Department of Health & Human Services, 2009

Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform.

Mental Health Care: Better, Not Best

Source: Health Affairs, Volume 28, Number 3, May/June 2009
(subscription required)

From the introduction:
Clearly,well beyond implementation of parity laws,much remains to be done to improve both treatment and quality of life for the mentally ill. Robert Drake and colleagues focus on Social Security Disability Insurance, since more than a quarter of adults on SSDI have a primary psychiatric impairment.Most want to work but are limited to no more than twenty hours a week–when the evidence suggests that “supported employment” would both save money and help them do better.

What’s more, many proposals now popping up as health reform initiatives could improve mental health treatment immeasurably. Comparative effectiveness research has already established that the older generic antipsychotics work as well as a class as the newer, branded, more expensive atypical ones. And steppedup quality improvement efforts, write Audrey Burnam and colleagues, could increase the effectiveness of mental health treatments provided to veterans.

This issue of Health Affairs focuses on mental health reform. Some of the articles include:

Better But Not Best: Recent Trends In The Well-Being Of The Mentally Ill
Sherry A. Glied and Richard G. Frank

Trends In Mental Health Cost Growth: An Expanded Role For Management?

Richard G. Frank, Howard H. Goldman, and Thomas G. McGuire

Implementing Mental Health Parity: The Challenge For Health Plans

Keith Dixon

The Changing Role Of The State Psychiatric Hospital

William H. Fisher, Jeffrey L. Geller, and John A. Pandiani

Mental Illness In Nursing Homes: Variations Across States

David C. Grabowski, Kelly A. Aschbrenner, Zhanlian Feng, and Vincent Mor

Starvation Diet: Coping With Shrinking Budgets In Publicly Funded Mental Health Services

Steve Bogira

Use of Electronic Health Records in U.S. Hospitals

Source: Ashish K. Jha, Catherine M. DesRoches, Eric G. Campbell, Karen Donelan, Sowmya R. Rao, Timothy G. Ferris, Alexandra Shields, Sara Rosenbaum, and David Blumenthal, New England Journal of Medicine, Vol. 360 no. 16, April 16, 2009
(subscription required)

From the abstract:
Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals.

On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems.

The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.

The Effect of an Employer Health Insurance Mandate on Health Insurance Coverage and the Demand for Labor: Evidence from Hawaii

Source: Thomas C. Buchmueller, John DiNardo, Robert G. Valletta, Institute for the Study of Labor, IZA Discussion Papers, IZA DP No. 4152, April 2009

Over the past few decades, policy makers have considered employer mandates as a strategy for stemming the tide of declining health insurance coverage. In this paper we examine the long term effects of the only employer health insurance mandate that has ever been enforced in the United States, Hawaii’s Prepaid Health Care Act, using a standard supply-demand framework and Current Population Survey data covering the years 1979 to 2005. During this period, the coverage gap between Hawaii and other states increased, as did real health insurance costs, implying a rising burden of the mandate on Hawaii’s employers. We use a variant of the traditional permutation (placebo) test across all states to examine the magnitude and statistical properties of these growing coverage differences and their impacts on labor market outcomes, conditional on an extensive set of covariates. As expected, the coverage gap is larger for workers who tend to have low rates of coverage in the voluntary market (primarily those with lower skills). We also find that relative wages fell in Hawaii over time, but the estimates are statistically insignificant. By contrast, a parallel analysis of workers employed fewer than 20 hours per week indicates that the law significantly increased employers’ reliance on such workers in order to reduce the burden of the mandate. We find no evidence suggesting that the law reduced employment probabilities.

Health Insurance Coverage of New York’s Home Care Aides: Findings from a 2008 Survey of Home Care Employers Outside New York City

Source: Paraprofessional Healthcare Institute, Health Care for Health Care Workers, April 2009

New York State’s home care workers, who each day serve our health care system, too often lack access to affordable, quality health insurance coverage. At the same time, employers find it challenging to recruit and retain enough workers to meet the increasing demand for services. While lack of adequate, affordable health insurance for home care workers and their families is known to contribute to workforce instability and vacancies, accurate and timely data on the availability of health insurance is simply not available to guide New York policymakers.

There are numerous reasons for policymakers to make this a priority. Direct-care workers comprise the largest group of workers in the state’s health sector and their numbers are expected to continue to grow. In addition, these workers are employed by agencies that are heavily dependent on public funds to provide services; i.e., these workers could be described as subcontracted “public employees.” In addition, direct-care workers face high rates of chronic health conditions and workplace injuries. This situation, in concert with low rates of insurance coverage, contributes to high rates of turnover, which undermines the quality of services for consumers.
See also:
Is New York Prepared to Care?
Press release

Medicare Advantage Plans

Source: Health Affairs and the Robert Wood Johnson Foundation, Health Policy Brief, April 29, 2009

From the RWJF summary:
Medicare was created in 1965 to provide government-subsidized health insurance for elderly and disabled Americans. Since the 1970s, beneficiaries have had the option of leaving traditional Medicare and enrolling in privately run health insurance plans that participate in what is now called the “Medicare Advantage” program.

This year, the government will pay these private plans an average of 14 percent — or about $12 billion — more than it would pay for people in traditional Medicare. “This added cost contributes to the worsening long-range financial stability of the Medicare program,” said the Medicare Payment Advisory Commission (MedPAC), a nonpartisan group Congress established to monitor Medicare, in a March 2009 report to Congress.

MedPAC has proposed calculating the payments differently, to eliminate the extra cost of Medicare Advantage and to slow Medicare’s growing costs. Others, including the Obama administration, want the plans to bid against each other for Medicare contracts in the hope of achieving greater savings to put toward health reform.

Health Care Opinion Leaders Survey

Source: Commonwealth Fund/ Modern Healthcare, Press Release, April 27, 2009

Health care leaders believe the U.S. must rein in the growth of health spending, and most believe it is possible to keep the share of gross domestic product (GDP) now spent on health care steady over the next 10 years. Nearly all respondents (96%) to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey agreed that spending must slow and large majorities expressed support for a range of strategies to reduce costs, including many of those outlined in President Obama’s budget blueprint. Currently, the nation as a whole spends 17 percent of GDP on health care; that proportion is projected to grow to 21 percent by 2020.